Влияние варикоцеле на органы малого таза. Простатит/Везикулит/Преждевременная эякуляция etc.

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Slac1e
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#1 Сообщение Slac1e » Сб июн 08, 2019 4:52 am

Создание отдельной темы - попытка найти наиболее информативные исследования среди англоязычной литературы, которые описывают существующие и возможные маханизмы влияния варикоцеле на органы малого таза. Совершенно противоположный итоговый результат после проведения операции среди форумчан данного форума демонстрирует наличие недостатка необходимых знаний и данных, на основании которых можно было провести некую корреляцию и приблизиться к решению проблемы. Пусть эта тема поможет каждому, кто волей-неволей вынужден искать ответы сам.

Убедительная просьба ко всем форумчанам - использовать данную тему исключительно в ознакомительных целях. Будет намного лучше, если вопросы, которые Вас беспокоят будут заданы в соседней теме. Огромное спасибо за понимание)
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#2 Сообщение Slac1e » Сб июн 08, 2019 5:22 am

The Association between Varicocele, Premature Ejaculation and Prostatitis Symptoms: Possible Mechanismsjsm

Francesco Lotti, MD and Giovanni Corona

J Sex Med 2009

Ссылка на оригинальную работу:

https://yadi.sk/i/U2Z9yT2rNqh1cg

Наиболее важные моменты:

Subjects with severe echographic varicocele showed higher seminal interleukin-8 (P < 0.05); in addition they presented a higher prevalence of ultrasound signs of prostatitis, such as hypoechoic prostatic texture (P < 0.02), prostatic calcifications (P < 0.001), higher seminal vesicle anterior-posterior diameter before ejaculation (P < 0.05), and higher prostatic venous plexus diameter (P < 0.0001) (Figure 2). All of these associations were confirmed at multivariate analysis after adjustment for age (Hazard ratio = 4.73[1.81–12.41], P < 0.005, 3.95[1.62–9.64], P < 0.005, 1.17[1.03–1.33], P < 0.05 and 1.53[1.27– 1.84],P <0.0001,for the presence of prostatic calcification, hypoechoic prostatic texture and for each millimeter increment of anterior-posterior seminal vesicle diameter or prostatic venous plexus diameter, respectively). Venous reflux velocity in the internal spermatic vein correlated with arterial prostatic blood flow peak velocity (r = 0.312; P < 0.005).

The presence of any degree of echographic varicocele was also significantly (P < 0.05) associated with symptoms of prostatitis, as measured by NIH-CPSI scoring and in particular with the pain domain (Table 2). These associations were confirmed after adjusting for age (Hazard ratio = 1.06[1.01–1.13], P < 0.05 and 1.12[1.00–1.26], P = 0.05 for total score and pain domain, respectively).

We alsoconfirmthepreviouslyreportedassociationof varicocele with prostatitis [11,12] which is a wellknown risk factor for premature ejaculation [14–18;forreview,see19,20].

It can be speculated that varicocele, leading to intrapelvic congestion and prostatic inflammation, could be the primum movens for the onset of premature ejaculation, at least in some subjects. It has been reported that varicocele is associated with an underlying systemic venous abnormality [11,41,42], and with an increased diameter of the prostatic venous plexus in particular [43].

In addition, Gat et al. [44] recently demonstrated the presence of a venous blood reflux from the high pressure testicular venous drainage system to the low pressure prostatic drainage system, through a direct communication represented by the deferential vein and the vesicular plexus. It can be speculated that the presence of communication between the testicular and the prostatic venous system might justify a back-flow of venous blood from the testis to the prostate, which can lead to intrapelvic venous congestion. This could facilitate the onset of symptoms of prostatitis. Accordingly, it has been demonstrated that the selective occlusion of impaired venous drainage in the male reproductive system was associated with a reduction in prostate volume and benign-prostatic-hyperplasia-related symptoms [44]. Our findings are in line with this evidence. In fact, subjects with severe echographic varicocele were characterized by increased seminal interleukin-8 levels (a surrogate marker of non-bacterial prostatitis; [36]) and a higher prevalence of echographic signs of prostate inflammation. In addition, we found an association between the presence of any degree of echographic varicocele and symptoms of prostatitis, as measured by NIHCPSI scoring [10,37].

Signs and symptoms of prostatitis are more common in patients with varicocele, who more often complain of premature ejaculation. Premature ejaculation should be considered a marker underlying organic diseases including varicocele, and chronic prostatitis could be the link between the two conditions.

Позже выложу перевод.
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#3 Сообщение Slac1e » Сб июн 08, 2019 5:17 pm

Перевод

Связь между варикоцеле, преждевременной эякуляцией и симптомами простатита: возможные механизмы

Субъекты с выраженным эхографическим варикоцеле показали более высокий уровень семенного хемокина - Интерлейкин 8 (P < 0.05); Кроме того, они демонстрировали более высокую распространенность ультразвуковых признаков простатита, такие как гипоэхогенная простатическая текстура (P < 0.02), кальцинаты предстательной железы (P < 0.001), и больший диаметр простатического венозного сплетения (P < 0.0001) (Рисунок 2). Все эти связи были подтверждены при многократном анализе после поправки на возраст. (Отношение рисков = 4.73[1.81–12.41], P < 0.005, 3.95[1.62–9.64], P < 0.005, 1.17[1.03–1.33], P < 0.05 и 1.53[1.27– 1.84],P <0.0001, на наличие кальцинатов простаты, гипоэхогенной текстуры предстательной железы и прирост на каждый миллиметр диаметра семенных пузырьков или диаметра простатического венозного сплетения соответственно). Скорость венозного оттока во внутренней семенной вене коррелирует с максимальной скоростью артериального простатического кровотока (r = 0.312; P < 0.005).

Наличие какой-либо степени эхографического варикоцеле также значительно (P < 0.05) ассоциировалось с симптомами простатита, определенными с помощью шкалы симптомов хронического простатита национального института здравоохранения(NIH-CPSI), включавшую оценку области боли (Таблица 2). Эта связь были подтверждена после поправки на возраст(Отношение рисков 1.06[1.01–1.13], P < 0.05 и 1.12[1.00–1.26], P = 0.05 для общего балла и области боли, соответственно).

Мы также подтверждаем ранее сообщаемую ассоциацию варикоцеле с простатитом [11,12] который является хорошо известным фактором риска преждевременной эякуляции [14–18; для просмотра см.19,20].

Можно предположить, что варикоцеле, приводящее к внутритазовому застою и воспалению предстательной железы, может быть первичным поводом для начала преждевременной эякуляции, по крайней мере, у некоторых субъектов. Сообщалось, что варикоцеле связано с основной системной венозной аномалией [11,41,42] и с увеличенным диаметром простатического венозного сплетения в частности [43].

Кроме того, Гат и др. [44] недавно продемонстрировали наличие рефлюкса венозной крови из венозной дренажной системы яичка высокого давления в простатическую систему низкого давления, через прямую связь, представленную семявыносящей веной и везикулярным сплетением.

Можно предположить, что наличие связи между яичком и простатической венозной системой может обосновать обратный отток венозной крови от яичка к предстательной железе, что может привести к внутритазовому венозному застою. Это может способствовать появлению симптомов простатита. Соответственно, было продемонстрировано, что избирательная закупорка нарушенного венозного оттока в мужской репродуктивной системе была связана с уменьшением объема простаты и симптомами, связанными с доброкачественной гиперплазией предстательной железы [44]. Наши выводы соответствуют этим доказательствам. В действительности, субъекты с выраженным эхографическим варикоцеле показали более высокий уровень семенного хемокина - Интерлейкин 8(суррогатный маркер небактериального простатита; [36]) и более высокую распространенность эхографических признаков воспаления простаты. Кроме того, мы обнаружили связь между наличием любой степени эхографического варикоцеле и симптомами простатита, измеренными по шкале NIHCPSI.[10,37].

Признаки и симптомы простатита чаще встречаются у пациентов с варикоцеле, которые чаще жалуются на преждевременную эякуляцию. Преждевременная эякуляция должна рассматриваться как маркер, лежащий в основе органических заболеваний, включая варикоцеле, а хронический простатит может быть связующим звеном между этими двумя состояниями.
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#4 Сообщение Slac1e » Сб июн 08, 2019 9:38 pm

Reversal of benign prostate hyperplasia by selective occlusion of impaired venous drainage in the male reproductive system: novel mechanism, new treatment

Y. Gat, M. Gornish

July 30, 2008

Выдающаяся работа. Настоятельно рекомендую к ознакомлению:

https://yadi.sk/i/3XgiOiBRoQwfsg

Важнейшие моменты:

When the valves are destroyed, venous blood in the ISVs cannot flow upwards. The drainage from the testes is diverted into three other channels with elevated pressure. One of these, the DV, which drains the testes, creates hydraulic connection with the PVP, which drains the prostate via the VV. The VV, being the connecting vessel between the two systems, is a common space shared by the testicular and the prostate drainage systems. On the side of the prostatic drainage system, there is physiological pressure; however, on the side of the testicular drainage systems the pressure is substantially higher. Venous blood from the testicular side will flow retrograde into the prostate venous drainage (via the VV and the PVP), reaching the prostate (study 4 & Fig. 3) at elevated hydrostatic pressure with elevated concentration of FT. It should be noted that in quadruped animals, the venous drainage of the reproductive system is horizontal and therefore does not need one-way valves. Studies on animal models have shown that by an artificial increase of the intra-abdominal pressure in a canine model, radiopaque contrast material can be transferred from the DV directly to the prostate (Pierre point et al., 1975; Dhabu-walaet al., 1978).
These comparative anatomical data further confirm and support the clear, hydraulic effects that we expected in our study regarding the connection between the testicular and prostate drainage systems that the fluid dynamics of both systems obey the principle of ‘communicating vessels’, where any change in the pressure of one system causes immediate changes in the pressure and in the flow directions in the other connected system to the point that the fluid dynamic equilibrium is conserved (Bernoulli’s principle). Two parallel effects then occur in the prostate, a rapid mechanical effect – hypertrophy; and a slower, biologicalprocess – hyperplasia.


Benign prostate hypertrophy is caused by increased hydrostatic pressure in the prostate drainage system,while benign prostate hyperplasia is caused by anexcessively high concentration of free testosterone;both arriving from the testes to the prostate by pathological back-pressure and back-flow through the testicular and the prostate drainage systems.

Eliminating the pathological hydrostatic pressure in the testicular venous drainage system by occlusion ofthe impaired ISVs, including all the associated venous bypasses and retroperitoneal collaterals by super-selective transvenous sclerotherapy or by microsurgery, eliminates the venous back-pressure and the back-flowof blood to the prostate. This reduces its exposure to elevated free testosterone. This initially reduces benignprostate hypertrophy, and subsequently, at leastpartially, reverses benign prostatehyperplasia.
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#5 Сообщение Slac1e » Вс июн 09, 2019 1:04 am

Is varicocele associated with underlying venous abnormalities? Varicocele and the prostatic venous plexus.

Sakamoto H, Ogawa Y.

J Urol. 2008

Ссылка:

https://www.ncbi.nlm.nih.gov/pubmed/18710746

Важнейшие моменты:

Mean diameter, and peak and antegrade flow velocity of the prostatic venous plexus were greater in men with bilateral varicoceles than in those with a unilateral varicocele and in those without a varicocele (p <0.01). Moreover, men with a unilateral varicocele had a greater mean peak antegrade flow velocity than those without a varicocele (p <0.05). However, mean diameter and peak retrograde flow velocity were not different in men with a unilateral varicocele and those without a varicocele. In 10 men with a left clinical varicocele mean diameter, and peak retrograde and antegrade flow velocity of the prostatic venous plexus did not differ before vs after varicocele repair. In all men the diameter of the prostatic venous plexus positively correlated with the diameter of the right and left pampiniform plexus (p <0.0001).
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#6 Сообщение Slac1e » Вс июн 09, 2019 3:02 am

Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases

Jin Wang, Qian Liu, Xun Wang

Sci Rep. 2018

Ссылка:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809367/

Статья посвящена Модифицированному методу варикоцелэктомии, но в ней удалось найти информацию, которая основательно подкрепила теорию о связи варикоцеле и простатита:

According to the EAU Guideline and Guideline for Diagnosis and Treatment of Urological Disease in China (2014), the indications of varicocelectomy were:
(1) infertility because of low semen quality;
(2) scrotal pain;
(3) persistent prostatitis with clinical palpable varicocele;
(4) no symptoms, but varicocele in Grade 3 was found in medical examination (entrance examination for some special professions in China, such as pilots and soldiers);
(5) testicular atrophy in adolescents.


В соответствии с руководством европейской ассоциации урологов и руководством по диагностике и лечению урологических заболеваний в Китае (2014), показания к варикоцелэктомии:
(1) бесплодие из-за низкого качества спермы;
(2) боль в мошонке;
(3) устойчивый простатит с клинически выраженным варикоцеле;
(4) никаких симптомов, но варикоцеле в 3-м классе было обнаружено при медицинском обследовании (вступительный экзамен для некоторых специальных профессий в Китае, таких как пилоты и солдаты); (5) атрофия яичек у подростков.

P.S. Уверен, многие участники форума, которые неоднократно были у урологов в связи с варикоцеле задали бы резонный вопрос:"Почему подавляющие большинство урологов на постсоветском пространстве смеются в лицо пациентам, когда те предполагают о наличии связи между болевым эффектом/симптоматикой простатита и варикоцеле, направляя к неврологам и/или выписывая тонну антибиотиков с десятками физ. процедур?"
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#7 Сообщение Slac1e » Вс июн 09, 2019 4:42 pm

The effectiveness of varicocele embolisation for the treatment of varicocele related orchalgia

David W Muthuveloe, Vinnie During

Muthuveloe et al. SpringerPlus (2015) 4:392

Ссылка:

https://yadi.sk/i/NFuVzrNAhmTb5w

Важнейшие моменты:

A total of 96 cases were identified. The mean age was 34 (17–75). 89% were located on the left side, 6% on the right side and 5% were bilateral. The mean number of coils used was 4 (2–8). The median time from embolisation to post operative questionnaire response was 12 months (95% CI). Post-embolisation median pain scores reduced significantly in all three pain cohorts (least pain, typical pain and worst pain) when compared to the pre-embolisation pain scores (p < 0.001) (Fig. 1). Overall 74% of patients had improved pain post procedure, of which 30% had no pain following embolisation. 24% patients had no change in symptoms and 1% patient had worsening symptoms(Table 1). The average post-procedure decrease in pain score in those with mild, moderate and severe pain was 1.2, 4 and 4.4 respectively. Post-embolisation analgesia requirements were
reduced when compared to pre-embolisation analgesia requirements. Those patients who often/always took analgesia for pain pre-embolisation experienced either moderate or severe pain (Fig. 2). Varicocele embolisation reduced this number from 51 to 20 (a reduction of 62%). Overall 53% of cases went from requiring some form of analgesia pre-embolisation to never requiring analgesia whatsoever. The overall median satisfaction score was 8 (VAS: 0–10, 10 = completely satisfied) (Fig. 3).

In our study, varicocele embolisation was a well tolerated procedure with a median satisfaction score of 8/10. We were concerned about the biased caused by symptom severity and satisfactions scores. It could be argued that a small improvement in those cases with severe pain, leads to a subjectively greater response than those cases with mild pain. As a result the satisfaction seen with those patients would have been greater. However this was not found to be the case. Both groups with severe and mild symptoms pre-procedure had a median satisfaction score of 7 showing that the severity of the symptoms did not skew the satisfaction score.
In this study the mean number of coils used was 4 (2–8), which is comparable to the documented literature of 5 (Iaccarino and Venetucci 2012). However the variability of techniques was not established with certainty.
Although there is national and international consensus on how this procedure should be performed, this study did not look into details about each operator’s technique. In addition the number of coils used could also be an independent prognostic factor. From this study it is unclear whether the number of coils used is related to the success rate of treatment and in turn improvement of pain. Further investigation into this area should be considered.

In our review we have demonstrated that primary varicocele embolisation can decrease discomfort in those with symptomatic varicoceles, with an overall reduction of pain in the majority of cases. Patients with mild pain may not experience as much benefit as those with more severe pain. As such the severity of scrotal pain in the presence of varicoceles has been found to be an important independent prognostic indicator. Therefore the classification of patients into those with mild, moderate or severe symptoms prior to embolisation should be performed so robust consenting can be achieved.

P.S. Для тех, кто с пеной у рта доказывает, что варикоцеле не может давать болевого эффекта стоит внимательно прочитать всю статью.
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#8 Сообщение Slac1e » Вс июн 09, 2019 5:24 pm

Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system

Dr Yigal Gat

Vol 13. No 4. 2006 510-515 Reproductive BioMedicine Online

Ссылка:

https://yadi.sk/i/ennvyy2-pSM4xg

Важнейшие моменты:

Using thermography, combined with ultrasonography and confirmed by venography, it has been shown that varicocele can be identified in over 80% of infertile men and that 84% are bilateral (Gat et al., 2004b). In the light of the above, the prevalence and significance of right varicocele were investigated by venographies and fluid mechanics analysis. The reason why right varicocele cannot be clinically detected was also investigated. This lack of detection leads to partial treatment in about 80% of infertile men, causing clinicians to dissociate varicocele from male infertility.

Based on our findings, varicocele is a bilateral vascular disease. The right side is affected in 86% of infertile men with varicocele. The disease is associated with a complex network of bypasses and retroperitoneal collaterals. In 92% of the patients, no reflux occurs to the right spermatic vein, even by Valsalva manoeuvre, and therefore right varicocele cannot be detected by palpation. Pathological hydrostatic pressure exists in the right internal spermatic veins, causing hypoxia in the seminiferous tubules, Sertoli and Leydig cells, and exists regardless of the presence of back-flow, depending only on the vertical height of the right ISV, and its venous bypasses.

Thermography, based on heat conductivity, is the best screening tool for detecting right varicocele. Ultrasonography is less sensitive than thermography but these combined tools yield the best results. Percutaneous transvenous occlusion (embolization) or bilateral microsurgery of the entire impaired testicular venous drainage system can effectively eliminate the increased hydrostatic pressure. This permits the return of normal supply of oxygenated arterial blood flow and nutrient material into the testicular microcirculation and the sperm production site.
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#9 Сообщение Slac1e » Сб июн 15, 2019 1:06 am

Effect of Microsurgical Subinguinal Varicocele Repair on Chronic Dull Scrotal Pain in Men with Grade II-III Lesions

Saad Elzanaty, Claus E. Johansenb

Curr Urol. 2017

Ссылка:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385864/

Наиболее важные моменты:

Our study was based on 29 patients with a grade II-III varicocele and chronic dull scrotal pain who had undergone microsurgical subinguinal varicocele repair and were followed-up for 6–12 months after surgery including assessment of scrotal pain. Of these 29 patients, 28 (97%) reported a complete resolution of pain. Our results are in accordance with previous reports [2,4,6,8]. We, therefore, believe that microsurgical varicocele repair should be considered in men with a grade II-III varicocele and chronic dull scrotal pain.

It has been reported that the success of the surgical treatment of painful varicoceles depends on the character of the pain. Thus, it has been observed that patients who presented with dull non-radiating scrotal pain had a significantly higher rate of success in terms of resolution of pain than those who presented with sharp scrotal pain [3]. The duration of pain was also reported to affect the success of the surgical treatment of painful varicoceles. Previous studies showed that men who presented with a long period of scrotal pain (> 3 months) had a significantly higher rate of success in terms of resolution of pain after surgery as compared to men who presented with a short period of scrotal pain (< 3 months) [7]. In accordance, our patients presented with dull non-radiating chronic scrotal pain.

Persistence/recurrence of a varicocele is an additional factor that should be considered when evaluating the success of the surgical treatment of painful varicoceles. In this matter, microsurgical varicocele repair was reported to be associated with a significantly lower rate of persistence/recurrence than non-microsurgical varicocele repair [9,10]. The contribution of the gubernacular vein to postoperative persistence/recurrence is still unclear. Goldstein et al. [11] performed 33 varicocele repairs using the non-microsurgical approach without delivery of the testis, 12 varicocele repairs using 2.5x loupes without delivery of the testis, and 326 varicocele repairs using the microsurgical approach with delivery of the testis and reported a persistence/recurrence rate of 9 %, 8%, and 0.6%, respectively. Schiff et al. [12] performed 74 varicocele repairs using the microsurgical subinguinal approach. In each of the procedures, the testis was delivered and the gubernaculum was examined for the presence of any varicose veins between the gubernacular vein and the testis and any large veins were clipped and ligated. The authors reported no persistence/recurrence during the follow-up period which was extended to a mean of 10 months. These results suggesting that deliver of the testis and examination of the gubernacular vein reduces the risk of persistence/recurrence. The patients included in our study underwent varicoceles repair using the microsurgical subinguinal approach. However, we did not deliver the testis out of the scrotum nor did we ligate the gubernacular vein, and persistence/recurrence was found in only one patient.

The resolution of scrotal pain after surgery could be attributed to the reduction of the pressure in the testicular venous drainage system, thus enabling normal oxygen flow to the testicles with correction of hypoxia in the testicular tissue caused by hydrostatic pressure resulting from the destruction of the one-way valves in the internal spermatic veins. In addition, resection of some of the spermatic nerves during surgery is another contributing factor for pain resolution.

With the assistance of the operating microscope and the Doppler probe, we were able to identify and preserve the testicular artery and the testicular lymphatics. None of our patients had testicular atrophy or hydrocele one year after surgery.

Our study has some limitations. This study was based on a relatively small number of patients with a specific type of painful varicocele and with no control group. Moreover, we were not able to investigate the effect of post operative time on the outcome results since scrotal pain was evaluated only once at the late fellow up visit. However, our results are still valid and support the notion that varicocele repair should be considered for men with clinical varicoceles and chronic scrotal pain.

In conclusion, the results from this study indicated that microsurgical subinguinal varicocele repair should be considered in men with grade II-III lesions and chronic dull scrotal pain.
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#10 Сообщение Slac1e » Сб июн 15, 2019 1:20 am

The Effects of Varicocelectomy on the Patients With Premature Ejaculation

Amir Abbas Asadpour, Mohammad Aslezare

Nephrourol Mon. 2014 May

Ссылка:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090664/

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In this clinical trial study, 124 patients aged 26 ± 4.5 years old, with varicoceles and PE were investigated. Following the varicocelectomy, 46 patients (37%) with PE (intravaginal ejaculatory latency less than 1-2 min) were fully treated with statistically meaningful difference in the ejaculation time (IELT > 5 minutes) (P < 0.001). Another 78 patients (63%) had improved PE changed to early ejaculation (2 < IELT < 5) (P < 0.05) following the varicocelectomy. These two groups were fully satisfied with these improvements. Out of 124 patients undergoing varicocelectomy, 89 patients (72%) had improved spermiogram parameters, following the surgery (P < 0.002).

Similar to the other studies, varicoceles showed to affect the sexual activity of many patients in the present study. It also had significant effects on sexual function of the patients, particularly on PE. In many studies varicocelectomy had improved the sexual satisfaction to different degrees. Our study also showed some degrees of sexual behavior improvement in patients. Altogether, all these facts prove that varicoceles may not only cause infertility, but can also strongly affect the sexual function and quality of life in many patients. It seems that for a significant number of patients with clinical grade 2-3 varicoceles, not well responding to medical treatments for PE (like paroxetin and clomipramine), varicocelectomy can be an alternative which effectively improves PE and spermiogram parameters.
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#11 Сообщение Slac1e » Сб июн 15, 2019 1:34 am

Clinical correlates of enlarged prostate size in subjects with sexual dysfunction

Giovanni Corona, Mauro Gacci

Asian J Androl. 2014 Sep-Oct

Ссылка:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215685/

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Accordingly, enlarged prostate size was also associated with a higher risk of arteriogenic erectile dysfunction (ED), as well as with other andrological conditions, such as varicocele and premature ejaculation (PE). PSA levels were significantly higher in subjects with enlarged prostate size when compared to the rest of the sample (HR = 3.318 (2.304; 4.799) for each log unit increment in PSA levels; P < 0.0001).

Among nonsexual clinical parameters, the presence of left clinical-derived varicocele was another condition significantly related to an increased risk of an enlarged prostate size (HR = 1.293 (1.119–1.494); P < 0.001). The association between varicocele and an enlarged prostate size was confirmed even when patients complaining of PE were excluded from the analysis (HR = 1.292 (1.085–1.539), P = 0.004).

Among other symptoms and signs, enlarged prostate size was related to PE and varicocele. We previously reported that varicocele is an independent risk factor for PE, closely associated with clinical and ultrasound features of prostatitis.
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#12 Сообщение Slac1e » Сб июн 15, 2019 1:54 am

A review of varicocele repair for pain

Ryan C. Owen, Benjamin J. McCormick

Transl Androl Urol. 2017 May

Ссылка:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503918/

Наиболее важные моменты:

Varicoceles occur in approximately 15% of the male population. Pain is a common complaint, affecting up to 10% of these patients. Many patients respond to conservative measures, but for patients with painful varicoceles who have failed non-surgical management and for whom other causes of scrotal pain have been ruled out, varicocele repair is indicated and has shown to be safe and effective. Though there exist several approaches to the procedure, an inguinal or subinguinal technique coupled with the use of the operating microscope and microvascular Doppler ultrasound has been shown to be the gold standard treatment. Using this approach, the incidence of varicocele recurrence/persistence, hydrocele formation, and testicular artery injury are negligible, and approximately 90% of patients will achieve symptomatic relief.
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#13 Сообщение Slac1e » Пн июн 17, 2019 10:31 pm

ADOLESCENT VARICOCELE: IS IT A UNILATERAL DISEASE?

YIGAL GAT, ZVI ZUKERMAN

PEDIATRIC UROLOGY

Ссылка:

https://yadi.sk/i/uaM-_CbqeH9WFQ

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The present study had two major findings. First, what was traditionally considered a predominantly unilateral anatomic abnormality apparently has a strikingly high incidence of bilaterally (85.7%). A high incidence of bilateral varicocele could explain the high rates of bilateral testicular dysfunction. The second finding was that only 10% of patients with right varicocele were diagnosed by physical examination and more than 85% were diagnosed by thermography with confirmation by venography. Therefore, we suggest that thermography and venography should play a major role in the diagnosis of varicocele.
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